Job Overview
Location
Remote Nationwide
Job Type
Full-time
Category
HR & Recruiting
Date Posted
May 20, 2026
Full Job Description
đź“‹ Description
- • The Senior Clinical Policy Research Professional works closely with Humana's dental and medical directors to research, develop, and maintain dental and medical coverage policies using an evidence-based medicine review process, directly impacting Medicare and Medicaid coverage decisions.
- • Day-to-day responsibilities include researching and developing coverage policies using standardized checklists and CMS guidance, providing verbal and written summaries to leadership and committees, conducting ad hoc research for case reviews, analyzing new CPT and HCPCS codes quarterly, and collaborating with the PAL team and interdepartmental stakeholders.
- • The role operates within Humana Inc., a leading U.S. healthcare company dedicated to improving health outcomes for Medicare and Medicaid beneficiaries, families, individuals, and military personnel through integrated insurance and CenterWell healthcare services.
- • The ideal candidate will strengthen their expertise in clinical policy development, evidence-based research, and healthcare regulation while gaining experience in cross-functional collaboration and independent project management within a mission-driven organization focused on whole-person well-being.
🎯 Requirements
- • Associate or bachelor's degree in dental hygiene or dental assisting
- • Appropriate state certification or licensure as a dental assistant or dental hygienist
- • 5 years or more of prior clinical experience
- • Proficiency with Microsoft Office products including Word and Excel
- • Master’s degree in health-or business-related field (preferred)
- • Utilization management experience (Medicare or Medicaid) (preferred)
🏖️ Benefits
- • Medical, dental, and vision benefits
- • 401(k) retirement savings plan
- • Paid time off including company and personal holidays, volunteer time off, and paid parental and caregiver leave
- • Short-term and long-term disability, life insurance
- • Bonus incentive plan based on company and/or individual performance
Skills & Technologies
See exactly how your profile matches this role — strengths, skill gaps, and what to do about them.
About Humana Inc.
Humana Inc. is a for-profit health and well-being company headquartered in Louisville, Kentucky. Founded in 1961, it provides health insurance, Medicare Advantage plans, Medicaid services, pharmacy benefit management, and clinical care through primary care centers. Serving millions of members across the United States, Humana focuses on integrated care delivery, home health, and wellness programs aimed at improving health outcomes and reducing costs for individuals, employers, and government partners.
Subscribe to the weekly newsletter for similar remote roles and curated hiring updates.
Newsletter
Weekly remote jobs and featured talent.
No spam. Only curated remote roles and product updates. You can unsubscribe anytime.
Similar Opportunities
Vanta, Inc.
4 months ago
Oxeon Partners
4 months ago
Substack Inc.
2 months ago
Wilson Human Capital Group, Inc.
2 months ago